Reduce Wait Times Research Articles

Small Donors, Big Impact: Optimizing Organ Utilization in Simultaneous Pancreas and Kidney Transplantation From Extra Small Pediatric Donors.

Simultaneous pancreas-kidney transplantation (SPK) is the preferred treatment for individuals with type-1 diabetes and end-stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis. This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain-dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20kg. All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re-exploration. During a 5-27-month follow-up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%-5.2%), with 100% graft and patient survival. This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk-benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates.

Real-Time Bus Route and Timing Information System using IoT

This system suggests a user-friendly online interface for accessing real-time routes and schedules of the bus. The system provides the most recent information about bus locations, routes, and anticipated arrival times by utilizing the Internet of Things (IoT) and Global Positioning System (GPS) capabilities. The technology continuously collects position data by installing GPS modules on buses and linking them to an IoT network. After that, the data is sent to a central server for processing and display. The web interface serves as the main point of contact for users, it displays the positions of buses in real-time on a map along with integrated route data. By seeing the real-time position and expected arrival time of approaching buses, passengers may easily plan their journeys by accessing the webpage from any device with an internet connection. In addition to reducing wait times, enhancing customer satisfaction levels, and facilitating better travel arrangements, this gives transportation authorities useful information for optimizing bus routes and schedules.

Does receipt of social housing impact mental health? Results of a quasi-experimental study in the Greater Toronto Area

Affordable housing is commonly described as an important determinant of health, but there are relatively few intervention studies of the effects of housing on health. In this paper, we describe the results of a quasi-experimental, longitudinal study investigating the impacts of receiving social housing among a cohort of 502 people on waitlists for social housing in the Greater Toronto Area, Canada. Specifically, we sought to determine if adults who received housing were more likely than a control group to show improvements in depression, psychological distress, and self-rated mental health 6, 12 and 18 months after moving to housing. Amongst the participants, 137 received social housing and completed at least one follow-up interview; 304 participants did not receive housing and completed at least one follow-up interview and were treated as a control group (47 people provided data to both groups). The difference-in-differences technique was used to estimate the effect of receiving housing by comparing changes in the outcomes over time in the housed (intervention) group and the group that remained on the waitlist for social housing (control group). Adjusted mixed effects linear models showed that receiving housing resulted in significant decreases in psychological distress and self-rated mental health between the groups. Improvements in self-rated mental health between the groups were observed 6, 12 and 18 months after receiving housing (6 months, +2.9, p <0.05; 12 months, +2.6, p <0.05; 18 months, +3.0, p <0.05). Reductions in psychological distress (-1.4, p <0.05) were observed 12 months after receiving housing. Overall findings suggest that receiving subsidized housing improves mental health over a 6-to-18-month time horizon. This has policy and funding implications suggesting a need to reduce wait times and expand access to subsidized housing.

Operationalisation of health equity principles in physiotherapy hospital triage policies

BackgroundHealthcare triage policies are vital for allocating limited resources fairly and equitably. Despite extensive studies of healthcare equity, consensus on the applied definition of equity in triage remains elusive. This study aimed to investigate how the principles of equity are operationalised in Australian hospital physiotherapy triage tools to guide resource distribution.MethodsA retrospective, qualitative content analysis of 13 triage policies from 10 hospitals across Australia was conducted. Triage policies from both inpatient and outpatient settings were sourced. Data were coded deductively using the five discrete domains of the multi-faceted operational definition of health equity posited by Lane et al. (2017): 1) point of equalisation in the health service supply/access/outcome chain, 2) need or potential to benefit, 3) groupings of equalisation, 4) caveats to equalisation, 5) close enough is good enough. Descriptive summative statistics were used to analyse and present the frequency of reported equity domains.ResultsWithin the included triage tools, four out of five domains of equity were evident in the included documents to guide decision making. Allocation based on perceived patient need and overall health outcomes were the central guiding principles across both inpatient and outpatient settings. Equal provision of service relative to patient need and reducing wait times were also prioritised. However, explicit inclusion of certain equity domains such as discrimination, ensuring equal capability to be healthy and other patient factors was limited.ConclusionsPhysiotherapy triage policies consider various domains of equity to guide resource allocation decisions. Policymakers and service providers can use the insights gained from this study to review the application and operationalisation of equity principles within their healthcare systems through mechanisms such as patient triage tools.

Mapping evidence on the factors contributing to long waiting times and interventions to reduce waiting times within primary health care facilities in South Africa: A scoping review.

Globally, reduction of patient waiting time has been identified as one of the major characteristics of a functional health system. In South Africa, 83% of the general population visiting primary healthcare (PHC) facilities must contend with long waiting times, overcrowding, staff shortages, poor quality of care, an ineffective appointment booking system, and a lack of medication. These experiences may, in turn, affect how patients view service quality. This scoping review was guided by Arksey and O'Malley methodological framework. The primary literature search of peer-reviewed and review articles was achieved through PubMed/MEDLINE, Google Scholar, Science Direct, and World Health Organization (WHO) library databases, using waiting times, outpatient departments, factors, interventions, and primary healthcare facilities as keywords. Two independent reviewers screened abstracts and full articles, using the set inclusion and exclusion criteria. We used NVIVO® version 10 software to facilitate thematic analysis of the results from included studies. From the initial 250 records screened, nine studies were eligible for inclusion in this scoping review. Seven papers identified the factors contributing to waiting time, and five papers mentioned effective interventions implemented to reduce waiting times within PHC facilities. Our analysis produced three (patient factors, staff factors, and administrative systems) and two (manual-based waiting time reduction systems and electronic-based waiting time reduction systems) main themes pertaining to factors contributing to long waiting times and interventions to reduce waiting times, respectively. Our results revealed that the patients, staff, and administrative systems all contribute to long waiting times within the PHC facilities. Patient waiting times recorded a wider and more evenly spread patient arrival pattern after the identified interventions in our study were implemented. There is a need to constantly strategize on measures such as implementing the use of an electronic appointment scheduling system and database, improving staff training on efficient patient flow management, and regularly assessing and optimizing administrative processes. By continuously monitoring and adapting these strategies, PHC facility managers can create a more efficient and patient-centered healthcare experience.

Optimizing electric vehicle charging scheduling using enhanced multi-agent neural networks with dynamic pricing

Electric vehicles have gained widespread recognition as an environmentally conscious mode of transportation, primarily due to significant technological advancements and reduced emissions. When seamlessly integrated into the smart grid infrastructure, these vehicles can serve as flexible energy consumers and potential energy storage units. However, the efficient management of charging stations due to dynamic load demand & pricing poses a significant challenge, aiming to reduce wait times for electric vehicle owners and reduce electricity costs. To overcome this challenge, this study proposes a solution based on dynamic pricing policy and the adaptive Markov decision process. The approach utilizes a reinforcement learning-enabled enhanced multi-agent neural network (EMANN) to optimize charging schedules. This adaptive Markov decision process achieved optimal scheduling by minimizing charging costs during off-peak hours while completing charging in the shortest possible time. Furthermore, a constrained policy is employed to train the enhanced neural network using reinforcement learning, allowing the network to learn and solve adaptive Markov decision processes directly. To evaluate the effectiveness of this solution, the study conducted a numerical experiment using real-time data from Tesla electric vehicles. Combined with queuing models, the EMANN yielded impressive results, including a peak savings of 19.05% and an average profit of $376.1 per kilowatt-hour, achieved within a network convergence time of 512 s. The proposed algorithm for scheduling electric vehicles has been proven to be efficient in addressing the complexities associated with managing electric vehicle charging stations.

Patients’ preferences, experiences and expectations with wait time until surgery in gynaecological oncology: a mixed-methods study in two gynaecological oncological centres in the Netherlands

ObjectivesPatient-centredness of care during wait time before surgery can be improved. In this study we aimed to assess (1) patients’ experiences with and preferences regarding wait time before surgery; (2)...

Running on Empty: Ontario Hospital Workers' Mental Health and Well-Being Deteriorating Under Austerity-Driven System.

The well-being of health care workers (HCWs) and the public in Ontario, Canada is at risk as the province's health care system is strained by neoliberal restructuring and an aging population. Deteriorating working conditions that preceded the COVID-19 pandemic further declined as the added challenges took their toll on the work force, physically and mentally. The pandemic-weary hospital staff, predominantly women, many racialized, are facing unprecedented challenges. They are experiencing stress, anxiety, and burnout from staffing shortages and the resulting increased workloads, long hours, and violence. Comprehensive telephone interviews were conducted with 26 HCWs from less highly paid occupations in a range of hospitals across the province. Thematic analysis reveals a critical need for policies and legislation ensuring increased funding, hospital capacity, and reduced wait times while providing HCWs with fair and equitable wages, increased staffing, mental health supports, greater respect and acknowledgment, and strong protections from violence and other workplace hazards.

Impatiently Waiting: Women Managers, Professionalism, Psychological Costs, and the Reduction of ER Wait Times

Administrative burden has emerged as a key theoretical framework for understanding onerous, burdensome, and slow citizen-state interactions. While most work to-date focuses on how the political process generates burdens, how citizens experience burdens, and how burdens affect street-level bureaucrats, this manuscript focuses on the understudied link between management and administrative burden. This link is essential to understanding administrative burden because burdens are often reflected in bureaucratic logics, standard operating procedures, and other administrative tools—all facets of an organization which management possesses some power over. This manuscript develops an argument which links the literature on gendered management, representative bureaucracy, and sex-based selection with reduction in wait times (a dimension ripe with psychological costs) since women in management positions tend to be more relational, transformational, and process-oriented than men, all behavioral characteristics which may link onto administrative burdens in predictable ways. An empirical test linking women managers to a reduction of wait times in Florida emergency departments reveals that hospitals managed by women observe lower wait times, on average, across four out of six interrelated processes. Supplemental analyses examine the link between professionalism and gender and find that women with a health background are effective in reducing some of the most complex dimensions of waiting.

Utilizing Local Anesthesia Only for Penile and Scrotal Urologic Surgery: A Prospective Study on Patient Tolerability and Surgical Outcomes for a Sedation-free Option

ObjectiveTo prospectively assess surgical outcomes, complications, and patient-reported tolerability of invasive scrotal surgeries under local anesthesia (LA) alone, without sedation, compared to tolerability of penile procedures commonly performed in this manner. MethodsAdult patients undergoing penile and scrotal surgeries under LA only were enrolled from August 2022 to June 2023 (NCT05617261). Demographics, surgeon-perceived and patient-reported pain, and surgical variables were collected. Tolerability to the procedures and future anesthetic choice for a repeat procedure was assessed on follow-up. Complication data was collected, including recurrence, infection, excessive pain, and emergency room and family physician visits. Results107 patients were enrolled with a mean age ± SD of 42.2 ± 16.4 years. There was a 100% procedural success rate and no cases of perioperative complications or escalation of anesthetic. 92.4% (n=97) of patients indicated they would opt for LA only for a hypothetical repeat procedure. Of the minority opting for general anesthetic, most indicated discomfort or preferring an element of amnesia. No differences between intraoperative pain or tolerability scores of invasive scrotal procedures compared to penile procedures were observed. On univariate analysis, longer procedure duration (p=0.003), cannabis use (p=0.01), and higher intra-operative pain (p=0.005) was associated with lower tolerability. ConclusionLA alone in an office-based setting is promising for scrotal surgeries. It offers similarly high patient tolerability compared to procedures that are routinely performed under LA, with the preservation of outcomes. Adopting this method has the potential for substantial cost savings, reduced wait times, enhanced accessibility, and improved surgical efficiency.

Improving Medical and Surgical Care: A Qualitative Study of Medical Students' Experience With Language Barriers in Healthcare.

Objective This study aims to investigate the experiences of medical students in teaching and practice concerning communication with patients exhibiting limited English proficiency (LEP). With a growing population in the United Kingdom facing language barriers, this research explores the challenges encountered by medical students, emphasizing the need for enhanced medical education in this domain. Methods A qualitative technique was used to recruit 20 medical students enrolled in a Medicine MBBS degree program at a UK institution. Convenience sampling was utilized, and five separate focus groups were conducted. Semi-structured interview schedules guided discussions surrounding encounters with patients necessitating the use of interpreters. Thematic analysis was employed to identify recurring patterns and themes. Results Three primary themes emerged from the data analysis: interpersonal relations, feasibility, and duties and responsibilities. The findings underscore the challenges faced by medical students when communicating with patients having LEP. The study provides valuable insights into the nuanced aspects of these encounters, shedding light on the complex interplay between language barriers and effective healthcare delivery. Conclusion This research contributes to the limited body of qualitative literature on medical students' experiences in managing language barriers with patients. The identified themes provide a foundation for modifying medical education curricula to better equip students to address communication challenges associated with linguistic diversity. The study advocates for the integration of these experiences into medical training, emphasizing the broader implications for healthcare delivery and the reduction of health inequalities in linguistically diverse patient populations. The study also recommends the usage of up-to-date translation services built into the electronic healthcare records. This relationship minimizes inaccuracy in presenting the results of patient diagnostic films and tests, reduces wait times for treatment, and contributes to an overall cost reduction within this healthcare sector.

PREEMPTIVE AND NON-PREEMPTIVE GOAL PROGRAMMING APPROACH TO INVENTORY OPTIMIZATION OF THE CENTRAL STERILE SUPPLY DEPARTMENT, UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

This research applied a multi-criteria optimization technique to analyse the inventory system of a Central Sterile Supply Department (CSSD) through preemptive and non-preemptive goal programming. Data on six raw materials and four finished products were collected, in addition to their costs, demand rates, shelf lives, and available capital. The developed objective function of the non-preemptive model combined four goals: inventory cost optimization (highest priority), inventory turnover, service level, and delivery lead time. The implemented model guaranteed zero stock-outs, reduced wait times between productions, timely product sales, and the elimination of unnecessary overall costs.

Access to Scientist Led Exercise Stress Echocardiography Reduces Wait Times and Improves Consumer Engagement

Access to Scientist Led Exercise Stress Echocardiography Reduces Wait Times and Improves Consumer Engagement

Demand and supply shocks derived from COVID-19 on the freight transportation system in Mexico

PurposeThis paper's purpose is twofold. First, based on a case study, it aims to comprehend the consequences of COVID-19 on the demand and supply shocks of the freight transportation system in Mexico. Second, it seeks to provide an integrated perspective of four transportation modes, which would help prepare public policies for future global pandemics.Design/methodology/approachAnalyzing the impact of the COVID-19 pandemic on the freight transportation system, which affects national and global economies, is essential to drawing valuable insights for the future. To facilitate international comparative analysis, conducting case studies at a country level was deemed necessary. As a result, a case study was conducted in Mexico using an integrated approach involving four transportation modes.FindingsTo manage disruptions in freight flow during uncertain conditions, a comprehensive perspective on the four modes of transportation and data-driven decision-making is crucial. Under this context, three initiatives can be identified: 1) establishing a National Center for Intelligence in Logistics to improve data-driven governance; 2) appointing the “Integrated Transportation Corridor Management Manager” (ITCMM) function to coordinate multiple authorities with different acting in critical freight transport corridors, and 3) creation of a digital tool based on millions of GPS data to monitor freight flows, allowing for collective intelligence among logistics actors.Research limitations/implicationsThis research's limitations are related to using non-standardized databases to gather information on four transportation modes. However, this limitation is also an interesting discovery. Mexico is becoming a strategic logistics hub between North America and Latin America, especially under the “Nearshoring” trend. Unfortunately, the lack of an integrated public policy in logistics and transportation reduces Mexico's capacity to deal with disruptions and its economic competitiveness.Practical implicationsThis research has identified practices that could be crucial in improving public policies to optimize shipping routes and reduce wait times while minimizing disruptions caused by unforeseen events. A concrete example is the digital platform called “eraclitux,” a computer tool similar to an Enterprise Resource Planning (ERP) system companies use. This tool can enable a “Control Tower” that monitors freight flow in transportation corridors under the supervision of “Integrated Transportation Corridor Management Managers.” The tool can make reactive and predictive decisions that help to enhance the logistics value provided by transportation infrastructure.Social implicationsThe importance of a well-coordinated and integrated public policy for freight transportation was identified to ensure better performance during disruptions. Delays in the flow of goods can significantly impact the supply of essential items such as food and medicine, ultimately affecting the population's quality of life.Originality/valueNumerous studies have been conducted to determine the extent of vulnerability and the impact of COVID-19 on freight transportation. However, most of these studies assume a developed market context or a single-mode transportation approach, which only applies to some situations. To gain a comprehensive understanding of how pandemics-induced demand and supply shocks affected freight transportation in developing countries such as Mexico, this paper offers insights from a four-transportation mode perspective. Mexico is facing a challenging Nearshoring trend in manufacturing, making it a significant logistics node between North and South America.

Quality assurance in cardio-pulmonary exercise testing

Abstract Introduction Quality assurance (QA) ensures agreed standards are being met and facilitates service improvement. Recent government initiatives aiming to increase diagnostic activity to reduce wait times emphasises the importance of a robust framework to assess standards and drive improvement. Quality frameworks exist for other areas of cardiac diagnostics but there is limited information on assessing quality in cardio-pulmonary exercise testing (CPET). Purpose We aim to develop and pilot a quality assurance framework for CPET. This will facilitate further QA development in this area and drive continuous service improvement. Methods Data were collected from June to November 2023. A random sample of 10% of tests were selected each month. A total of 39 tests were included. Our framework consisted of 30 checks across four domains: Requesting, data quality, reporting, and documentation. Checks were assessed for compliance using a Red, Amber, Green (RAG) rating system. Green - compliant. Amber - minor deviation (e.g., minor deviation from spirometry repeatability criteria). Red - significant deviation (e.g., incorrectly plotted VO2 peak). An overall test rating was then given: Green (≤ 3 amber), Amber (4 – 5 amber) and Red (&amp;gt; 5 amber or any red). Results The analysis comprised of individual domain checks and an overall test rating (OTR). Domain results (figure 1.) were: Requesting 95%; Data Quality; 89%, Reporting 96%; and Documentation 98%. OTRs (figure 2.) were as follows: Green (85%), Amber (13%) and Red (2%). Tests with a red OTR led to supportive discussions with operators, additional training and follow up QA. Protocol selection and spirometry repeatability were the most common individual check deviations (41% amber and 31% amber respectively). Conclusions Our QA framework showed that overall CPETs were being conducted to a high standard. There were however some variances identified which led to targeted staff training and additional audits to guide service improvement. Qualitative and subjective aspects of CPET make QA complex and a patient focused model should be employed. It is also salient to note that QA in CPET should be developed to be pragmatic and scalable to the service to ensure sustainability.Figure 1:Domain resultsFigure 2:Overall test rating

Optimizing Ketchup Manufacturing Process: A Tecnomatix Simulation for Reduced Waiting Time and Improve Operational Efficiency

This research investigates the optimization of a ketchup production factory layout using Tecnomatix Plant Simulation software to enhance resource utilization and production efficiency. Both push and pull system were used to analyzed the entire ketchup production process, from receiving raw tomatoes to the final product storage, incorporating various processing stations with different processing times. In a push environment, driven by predetermined schedules, the simulation results showed an increasing trend in throughput over 4, 7, 11, and 14 days, with significant efficiency gains over time. In a pull environment, driven by actual customer demand, throughput simulations of 50, 100, 200, and 500 units demonstrated increasing productivity with higher workloads. The findings highlight the importance of optimized workstation layouts to reduce idle time and improve workflow, emphasizing that while push environments maintain consistent productivity, pull environments offer greater efficiency through flexibility and responsiveness to demand.

Reducing Wait Times for Children's Developmental Disorders Consultations Via Simplified Primary Care Assessments

The number of children diagnosed with developmental disorders in Japan is increasing annually, primarily assessed byspecialized physicians in pediatrics, pediatric neurology, and child psychiatry. However, medical institutions for children withdevelopmental disorders often have fully booked schedules, forcing long waiting periods until initial consultations can be obtained. Onereason for this is the shortage of specialized medical institutions and specialists. Prolonged waiting periods may not only delayintervention and support but also exacerbate the child's symptoms and cause psychological distress to the caregivers. Therefore,reducing the waiting period for initial consultations from the perspective of early detection and early support is an urgent issue.However, there is insufficient research on how to shorten the waiting period. Therefore, we focused on local primary care physicians,who are familiar with shortening the waiting time for initial consultations at specialist medical institutions. This aimed to investigatewhether there was a change in the waiting time for initial consultations at specialist medical institutions when local primary carephysicians used a simplified assessment sheet supervised by pediatric specialists, and referrals were made to specialist medical institutionsafter assessment. The participants consisted of 15 individuals referred from primary care physicians to specialist medical institutions and15 who directly visited medical institutions, totaling 30 participants for evaluation. As a result, the group that made appointments andvisited specialist medical institutions directly showed significantly longer waiting periods than those assessed by primary care physiciansand referred to specialist medical institutions (p &lt; 0.05). Assessment and treatment of developmental disorders in early childhood haveprimarily been conducted at specialized medical institutions. Still, using a simplified assessment sheet by primary care physicians suggestsa potential reduction in the waiting time for initial consultations with specialists.

The lived experiences of transgender and gender-diverse people in accessing publicly funded penile-inversion vaginoplasty in Canada.

Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.

Can Nationwide Central Appointment Systems Reduce Waiting Times in Turkish Public Hospitals?

Health service delivery is an important component of a well-functioning health system. To achieve a competitive healthcare system, healthcare should be provided on time to avoid delays that could harm the patient. In this respect, patient wait time is an important indicator of health services delivery performance. Countries develop national or regional booking systems to manage patient wait times and healthcare delivery resources more efficiently. In this study; the effect of a national booking system on outpatient wait times in Turkish public healthcare settings was investigated. This study was conducted using anonymized national outpatient data sets for the year 2016 with permission from the Republic of Turkey Ministry of Health. The data was analyzed after pre-processing and transformation. As a result of the study, patient wait times were calculated, analyzed and evaluated according to province and facility care levels (secondary or tertiary). Results showed that in 2016, only 30.69% of outpatient visits had appointments and that the average waiting time for patients with appointments was 11.18% shorter than for patients without appointments. The results of this study fill a gap in the literature as almost no studies have investigated this issue due to a lack of administrative and clinical data and will provide important evidence for the improvement of health service delivery systems.

Fast-track knee pathway: A cost effective, quality improvement initiative for knee osteoarthritis

BACKGROUND: The prevalence of knee osteoarthritis is increasing due to population growth, ageing and other risk factors. However, the majority of patients can successfully manage their symptoms using conservative management strategies with only a minority requiring surgery. In 2019, a patient waited four years to be seen if deemed routine for an elective orthopaedic out-patient appointment in a large acute hospital in Ireland. OBJECTIVE: To establish a Fast-Track Knee Pathway in an Irish healthcare setting, creating a more efficient channel into elective orthopaedics for patients requiring surgical intervention whilst providing community-based care for those with non-surgical needs. METHODS: a) Establishment of a dedicated community-based physiotherapy and dietetic service for knee osteoarthritis, b) implementation of a Rapid Access Knee Clinic in elective orthopaedic clinics, and c) economic evaluation of the Fast-Track Knee Pathway’s cost effectiveness compared with the traditional pathway. RESULTS: 403 patients with knee osteoarthritis were removed from physiotherapy waiting lists with 9 patients requiring referral onwards to the Rapid Access Knee Clinic. On average there was a 64% reduction in wait time to access an orthopaedic consultant across 4 pilot sites. An incremental cost-effectiveness ratio of € 22,535.03 per QALY was estimated. Comparing this to the national accepted threshold of € 45,000 per QALY the Fast-Track Knee Pathway can be considered cost-effective. CONCLUSION: The Fast-Track Knee Pathway provides a fully integrated pathway of care for patients with knee osteoarthritis, facilitating earlier access to orthopaedic intervention. An economic evaluation concluded that this model of care is more cost-effective than the traditional pathway.